Hematopoiesis occurs where?

A. liver

B. spleen

C. kidneys

D. bone marrow

D. bone marrow

-red marrow actively produces blood cells

-red marrow is found primarily in the flat and irregular bones, such as the ends of long bones, pelvic bones, vertebrae, sacrum, sternum, ribs, flat cranial bones, and scapulae

Blood is a type of

A. connective tissue

B. peripheral organ

C. major organ

D. soft tissue

A. connective tissue

-the 3 major functions of blood are transportation (oxygen, nutrients, wastes, hormones) regulation (F&E, ph, body temp) and protection (combat foreign invasion, clotting)

Plasma contains all of the following except?

A. water

B. proteins

C. electrolytes

D. gases

E. RBCs

F. nutrients

G. waste

E. RBCs

-plasma is mostly water

Serum refers to plasma minus its

A. proteins

B. clotting factors

C. wastes

D. electrolytes

Blood is composed of mostly?

A. plasma

B. blood cells

A. plasma

-normally blood is about 55% plasma and 45% blood cells

Carbon dioxide attaches to the _______ of the hemoglobin.

A. heme

B. iron

C. globin

C. globin

-carbon dioxide diffuses from tissue cells into the capillary, attaches to the globin, and is transported to the lungs for removal

Erythropoiesis is stimulated by?

A. bone marrow

B. hypoxia

C. erythropoietin

D. iron absorbtion

B. hypoxia

-erythropoiesis is stimulated by hypoxia and controlled by erythropoietin which is synthesized by the kidneys.

-essential nutrients for erythropoiesis include: protein, iron, folic acid, cobalamin, riboflavin, and pyridoxine

 Which of these in not a function of the spleen?

A. filters old RBCs

B. lymphocytes storage

C. 30% platelets stored

D. antibody production in fetus

D. antibody production in the fetus

-it is RBC production in the fetus

Hemachromatosis

-reabsorbtion of what?

-what can it cause?

-early S&S?

-labs?

-treatment?

-reabsorbtion of iron in intestines (normal iron levels 2-6g, pts store 1/2-1 g per year; can reach above 50 g of iron)

-can lead to liver damage and cirrhosis, DM, bronzing of the skin, arthritis, cardiac damage and cardiomyopathy

-early S&S: fatigue, arthralgia, impotence, abd pain, weight loss; spleen/heptaomegaly upon physical exam

-elevated serum iron, TIBC, serum ferritin

-weekly phlebotomy: remove 500ml of blood q week until iron stores are normal, avoid iron in diet, uncooked seafoods

Neutropenia is defined as less than what ANC?

500

usually only low grade fever;

-redness, swelling, heat, pus not usually present

-any low grade fever in the neutropenic pt should be reported to MD

CBC with differential

-blood cultures, CXR, CT used to diagnose infection in the pt

-Cipro, Levaquin to reduce fever

-GMCSF / G-CSF: stimulate neutrophil/macrophage production

-broad spectrum ax (may be used prophlyactically)

-proliferation of abnormal WBC

-way too many WBCs

-bone marrow, where WBCs are produced, becomes over populated with abnormal WBCs

-this then spills over into peripheral blood

-acute is usually severe and aggressive, the WBCs are less mature

-chronic the WBCs are more mature, the onset is more gradual

acute myelogenous leukemia

acute lympocytic leukemia

chronic myelogenous leukemia

chronic lympocytic leukemia

Myelogenous leukemia = what cells?

lympocytic leukemia = what cells?

-granulocytes: basophils, neutrophils, eosinophils

-lymphocytes: T & B cells

-bone marrow aspiration and possible biopsy

-LP, CXR, CT can find infiltration into other systems

-Cytarabine

-continuous 7 day infusion

-14 days after start of chemo do bone marrow aspiration

-neutropenia: increased risk of infection/sepsis

-thrombocytopenia: increased risk of bleeding

-risk for tumor lysis syndrome

-when cancer cells are destroyed and the contents leak out into peripheral system

-contents are high in potassium, phosphorus, uric acid

-alopirinol given to reduce uric acid

-diuretics given to low potassium

-high dose radiation

-chemicals

-drugs

-viruses (Epstein Barr, HIV)

-genetic abnormalities

-anemia

-neutropenia

-malaise

-bleeding

-fever

-fatigue

-thrombocytopenia

-bony pain

-bruising

-night sweats

-WBC will be high poss over 100,000

-ANC will be low indicating nonfunctioning cells

higher doses of induction meds

(corticosteroids, vincristine, oncovin, methotrexate, elasparaginase)

-methotrexate can cause cystallization in kidneys, give with leucovorin as a buffer dose

-low dose chemo for 2-3 years

-6MP daily pill

-weekly methotrexate doses

-monthly iV push of vincristine

-decrease drug resistance

-minimize drug toxicity to pt

-interupt cell cycle at multiple points

PHILADELPHIA CHROMOSOME

-this is a translocation of genetic material between chromosomes 9 and 22

mature neoplastic granulocytes

-Gleevac, chemo pill taken at home

-Hydrea, chemo pill taken daily

-20% or greater WBCs are blast cells

-converting to acute leukemia

-bone marrow aspiration

-peripheral blood smear

-CBC with diff

-malaise

-anorexia

-GI/GU complaints

-thrombocytopenia

-fatigue

-lymphadenopathy

-hepatomegaly/splenomegaly

Fludarabine, Cytoxan, Leukeran, Treanda

-no cure

-total obliterate the bone marrow

-total body irradiation done sometimes

-high dose chemo may be used maybe used to wipe out bone marrow

Neupogen

-pheresis (filtering) is done for 2-3 days to harvest the stem cells

skin and Gi systems

-liver can be involved

-maculopapular rash on palms and soles

-skins peels off

-jaundice

-mild to severe diarrhea

-abd pain

-malabsorption

proliferation of REED-STERNBERG cells

(multinucleated)

-Epstein-Barr virus

-genetic predisposition

-occupational toxins

-HIV

-extralymphoid sites such as the liver

-if it begins above the diaphram it remains confined to the lymph nodes for a variable period of time

-most common enlargement of the cervical, axillary, inguinal nodes

- nodes are NOT painful

-fever

-pruritus

-wt loss

-weakness

-tachycardia

-ETOH INDUCES ABD PAIN

-cough, dyspnea, stridor, dysphagia

-hepatomegaly/splenomegaly indicate advanced diagnosis

-biopsy enlarged nodes

-CBC, SED rate, liver and renal labs

-bone marrow aspiration and biopsy

-CT scan: chest, abd, pelvis

Stage I - a single area

Stage II - present in one or two regions of the body

Stage III - both side of the diaphram involved

Stage IV - multiple areas

-A: no symptoms

-B: fevers, night sweats, wt loss > 10% in 6 months

-radiation 4-6 weeks everyday

-95% cure rate

-chemo regimens MOPP and ABVD

-intensive chemo

-bone marrow/peripheral stem cell transplant

-hematopoetic growth factos

-sperm banking

-2nd malignancies, ischemic heart disease

-nutritional deficiency r/t NV

-pancytopenia

-skin care r/t radiation

-R-CHOP

(rituxin, cytoxan, adriamycin, oncovin/vincristin, prednisone)

-high grade is aggressive with rapidly dividing lymph nodes

-immunosuppresive meds

-Ebstein-Barr Virus

-occupational carcinogens

-painless enlarged lymph nodes

-disease is widely disseminated at time of diagosis

-sperm banking

-2nd malignancies, ischemic heart disease

-nutritional deficiency r/t NV

-pancytopenia

-skin care r/t radiation

-they are abnormal and excessive

-they have a chromosomal abnormality (deletion, translocation)

-increase myeloma proteins

-normal antibodies are reduced

-pain esp in the spine, pelvis, and ribs

-osteoporosis develops as a result of the excessive cytokines (interlukins)

-vertebral collapse and spinal cord compression are common

-excess plasma in tissue

-monoclonal proteins of blood and urine

 -hypercalcemia

-pancytopenia

-xray shows bone erosions, thinning

-calcium elevation in blood

-renal insufficiency

-anemia

-bone lesions

-chemo 1st treatment to reduce plasma cells

(alkeran, BCNU, cytoxan, thalidomide)

-aredia, didronel, zometa inhibit bone breakdown

-if younger than 60 possible bone marrow transplant

-analgesics for pain, wt bearing excercise to absorb calcium, hydrate well for hypercalcemia

-hydrate: UOP of 1.5-2L which may require 3-4L intake

-pain management: NSAIDs, tylenol, lortab

-alternate rest and activity

-prevent fractures

wt bearing exercise

-use of braces

Only NS

-D5W/LR cause hemolysis

-ABO incompatibility

-hemolysis of RBCs

-usually develops within the first 15 mins

-leukocyte incompatibility

-can be prevented with a filter

-due to sensitivity to plasma proteins from donor

-more common in people with allergies

-antihistamines used as pre-med

-epinephrine or steroids can be used to treat a severe reaction

-pt with cardiac or renal problems at risk

-I&O, JVD, assess lungs

-sudden development of noncardiogenic pulmonary edema following a blood transfusion

-usually occurs 2-6 hrs after transfusion; can occur as late as 48 hrs

-antibody mediated reaction between recipient's WBCs and antiWBC antibodies from donors who were sensitized during pregnancy or previous transfusion

-causes pulmonary capillary inflammation leading to resp distress and/or death

-when replacement RBCs or blood exceeds total blood volume within 24 hrs

-citrate toxicity, hypocalcemia, muscle tremors, ECG changes

-S&S: nausea, weakness, diarrhea, paresthesias, paralysis of cardiac/respiratory muscles, cardiac arrest

-STOP THE TRANSFUSION

-notify MD and blood bank

-CBC and urinalysis

-complete transfusion reaction report

-document

-maintain IV with NS

-recheck pt identifiers

-VS

-save blood bag and tubing